Transcript Michel Leveque – Ecos 10 nov11

ECOS
Strasbourg
10 novembre 2011
Michel LEVEQUE
Faculté de médecine
ECOS (french) OSCE (english)
• Objective
• Structured
• Clinical
• Examination
OSCE
Objective
Structured
Clinical
Examination
Observable,
measurable
Tasks, to
solve
problems
Clinical
context, real
or simulated
Evaluation
the skills
Levels for evaluation
PERFORMANCE
SKILLS
KNOWLEDGE
For what?
• Explore the competencies or performance in :
– diagnostic
– interview
– examination
– assessment
– medical reasoning
– sharing médical decision
– treatment plan
– doctor patient relationship
WHO ?
Post graduate students
– Prerequisite for ECOS:
• Training in clinical
• Have skills….
WHEN ?
• Formative evaluation
– During the professionnal training
• Final evaluation
– Performance for professionnal certification
• Strasbourg:
– First expérience for training
– Today only final evaluation (efficiency)
HOW ?
• Path between stations:
– 19 stations ( U Laval)
– 7 stations (Strasbourg)
• On each station
– simulated patient
– Physician observer
– document specifying the task
HOW ?
• Path between stations:
– 19 station ( U Laval)
•
•
•
•
Clinical stations
Questionnaire station related with clinical station
Questionnaire station not related with clinical station
Rest station…
– 7 station (Strasbourg)
• Only clinical stations
Clinical station
• Patient (simulated)
• Task, problèms
• Observer rating
Questionnaire
station
• Questionnaire
• Open-ended
questions and short
Recommandation to the students
need clear , précise candidate instructions
•« Red them carefully before starting !!
•before any question
•if you are unclear as to what you are being ask
to do clarify the task with the examinator… »
Contents of stations
Commons situations in primary care
Examples …
• The diabetic foot
– Examination
• Announcement of a
diabetes
– Explanations
• Contraception
(teenager)
– Explanations and
prescription
• Infant immunization
– plan
• Announcement of a
AD
– Explanations
• Visual disorder
(elderly)
– Diagnostic and plan
Examples …
• Skin redness (Lyme)
– Diagnostic and plan
• Chronic complaint
– Relationship
• Insomnia
– assement and
prescription
• Sadness
– Diagnostic,
assement,suicidal
risk
• Fatigue
– Diagnostic and plan
Method
Team (professors, lecturers) only GP : n=15
- Step 1 : choice of situations
- Step 2: writing the clinical case
- Step 3: selection criteria
- Step 4: scientific validation
- Step 5: writing evaluation grid
- Step 6: test stations with GP
- Step 7: plan the examination
- Step 8: examination
Example (instruction for the student)
• Ms. Richard, 45, teacher, comes to you at the
request of others to a "loss of form": it sleeps badly,
crying often, feeling irritable and does not know
what is happening.
She is married with two children (16 and 20 years).
• Your task is to conduct the examination to clarify
the diagnosis and propose a course of action.
Example (instructions for the actor)
• You are Ms. Richard, 45, teacher. You tell the doctor
that you have at the request of your family,
because you have a loss of form. Your husband has
supported and is in the waiting room.
In response to questions from the doctor:
• • You can not stand your students
• You are no longer the household (too tired)
• Grocery shopping is a charge
• unrest begins one to two months
• No more appetite (loss of six pounds in 6 weeks)…
Example (evaluation grid)a
NOM et PRENOM :
Grille de correction :
Note/20
•Antécédents personnel
– dépression
– tentative de suicide
– épisode maniaque
– consommation alcoolisée
– prise de médicaments
1
0,5
0,5
0,5
0,5
Example (evaluation grid)b
• Symptomatologie dépressive
– humeur triste
– inhibition psycho-motrice
– dévalorisation
– troubles de l’appétit
– troubles du sommeil
• Soutien de l’entourage
• Idées suicidaires
2
2
2
0,5
0,5
1
2
Example (evaluation grid)
• Prise en charge
– énoncé du diagnostic
1
– traitement médicamenteux ou psychothérapie 1
– suivi rapproché dans les 8 jours
1
– arrêt maladie
1
• Empathie écoute, reformulation 0 – 1 – 2 – 3
• TOTAL :
The path
Station
2
Station
1
Station
3
ECOS
Station
7
Station
6
Station
4
Station
5
timing
• Each station: 7 minutes
• Clock : 1 minute for change
• Clock : start the station
To learn more about OSCE
• http://w3.fmed.ulaval.ca/cessul/index.php?id
=792
• http://w3.fmed.ulaval.ca/cessul/fileadmin/te
mplate/main/cessul/documents/document/P
PTECOSFaculte.mov
Centre d’Evaluation des Sciences de la Santé
Université de Laval
Step 4 scientific validation
Kamtchatka, Ru